Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | A81742 | CA |
Y | 207ND0101X | MOHS-Micrographic Surgeon | A81742 | CA |
N | 207NS0135X | Procedural Dermatology | A81742 | CA |
NPI | 1043313133 |
---|---|
Provider Name | Leslie Anne Storey |
First Address | Fresno, CA 93704-3628 |
Second Address | Fresno, CA 93711-6281 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/09/2006 |
Last Update Date | 05/11/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I25537 | (02) | CA |